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MARION COUNTY BUILDING INSPECTION <br />SENATOR BL.DG NO 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE:: $88-E147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE:: 588-7904 <br /> <br />The work will be gerformod b'~ a rog~storod builder <br />Other_ <br /> <br /> I II~we read and agree to the terms 8tared on the reverse side of <br /> <br />DAH-: 01/28/91 fI~4E: 11:27:24 <br /> WiL~, JOHN <br /> <br />DATE <br /> <br />TAX LOT <br /> 6'/'644-014 <br />CONSfROC'iION TYPE <br /> <br />RESI DEN 1 IAL <br /> <br /> 9292 ~/ti['H RD SE <br />AuM~VILLE OR 97325 <br /> <br />CONTRACT CITY U~S <br />I~,AR l ON CODN 1 Y NO <br /> <br />P.O. 983 <br />AUI~,SVILLE, OR <br />PHONE: 370-4589 <br /> <br />LOT SLOCK SECTION TOWNSHIP <br />51 <br /> <br /> 51TE NUMBER+. 12059 <br /> VALUA r I ON: <br /> <br />8.5 2W <br /> IRREG LO/ CORNER <br />AC NO NO <br /> <br />TYPE: ON-SIIE SEWAGE <br /> <br />PEk~411 OR APPLICAIioN NO; <br /> <br />CONtRACtOR, NO. <br />WILSON, JOHN <br />P.O. 982 <br />AUM~VILLE, OR <br />PHONE: 3'/0-4569 <br /> <br />29689 <br /> <br />WA1ER SUPPLY: P1N <br />T~F HOL~ READY; <br />SilE EYALLIA[iON NUF4BER: <br />EXlSFiNG rANK SIZE: <br />e.~iSliN6 DRAIN FIELD LINES: <br />SEPTIC rANK PUMPED: <br />PREVIOUS NO. BEDROOMS: <br /> <br /> i FE~4 <br />~ IHORIZAI ION NOT iCE - NO VlSi <br /> <br />PAYEE: <br />RECEIVBD BY: CL <br /> <br />rOTAL.nS~,~SSSO FEE~ <br />PREViOUS Rk~EiPTS <br />tHiS RECEIPF <br /> <br />BALANCg DUg <br /> <br /> (.,~JAN~i[Y AMOUNr <br /> $60.0o <br /> <br /> ~60.00 <br /> 50,00 <br /> $o.oo <br /> So. Do <br /> <br /> RECEIPF NO: <br />'IYPE: CH~CK ~: 0 <br /> <br /> $~g AITAOHED f)DCUMENI FOR RBC~.JIREMEN1S OF ON~$i1E SEWAGE SY~[EM. <br />~ THiS IS A VALID PE~iT * THIS PE~IT EXPIRE~ 360 DAYS FROM iTS iSSUE DATE. IF <br />CONSTRUOTiON FAILS TO MEET ALL R~0UiR~ME~TS OF STATE ~ AND MARION COUNTY BUILDING AND <br />ZONING ORDINANCES, THiS PE~IT ,SHALL ~ NULL AND VOID. <br /> <br />RBf4ARK$: SEPIiC SYSTEM NBVER PLACED iN USE, AUlH NO VlSi[ /~ <br />DONALD E. NOODLg¥, MARION COUNf'y BUILDING OFFiCiAL / BY~ <br /> <br />FORM # MC 15 ,5(;R~¥ 4/BO OFFICE COPY <br /> <br /> <br />